Routine hand hygiene has been cited by the World Health Organization and the Centers for Disease Control and Prevention as a cost-effective and important hygiene measure in preventing the spread of infectious diseases. (1-5) Several studies have explored children's hand hygiene habits, effects of scheduled hand hygiene, hand hygiene environmental barriers, educational programs, and application of various hand hygiene products, all with the aim of increasing the frequency of hand hygiene in children and decreasing absenteeism at school. Though these studies did have merit and achieved statistical significance, sustainability of hand hygiene was not evaluated. (6-9,11-14) In addition, no published peer-reviewed research was found that explored the influence of a verbal cue to action coupled with teacher modeling or hand hygiene education that included a visual experience for the children to see the effectiveness of their hand washing. Therefore, this project focused on 2 interventions. Intervention 1 involved verbal cue to action coupled with teacher modeling of hand hygiene, and intervention 2 involved teacher cue to action, hand hygiene education, and an opportunity for children to see the effectiveness of their hand hygiene efforts.
In 2006, a public elementary school with a range of household incomes from public assistance to $200,000+ per year, located in urban Utah, was selected for this study. A series of preliminary planning meetings with school officials and faculty was conducted to discuss the project goals, objectives, and protocols. The Joint Staff Service Committee, consisting of the principal, vice principal, and faculty members, was informed, and support for the project was obtained. The project was approved by the school district and the University of Utah's Institutional Review Board.
A total of 492 children, grades 1 through 6, participated in this project. From each grade, 3 classes were randomized to either a control group or 1 of 2 hand hygiene interventions. After receiving their assigned intervention, students were observed for hand hygiene behavior prior to lining up for lunch. After cueing students to line up for lunch, hand hygiene was recorded by classroom teachers for 1 week. After the observational period, each classroom received intervention 2 due to the remarkable increase in student hand hygiene of those originally assigned to this intervention. Three months post intervention, teachers recorded student hand hygiene behaviors in classroom prior to lining up for lunch. A hand hygiene attempt was defined as rubbing hands with alcohol hand sanitizer or applying soap to hands and rubbing under running water.
Phase I. Classrooms were divided into 3 groups: control, intervention 1, and intervention 2. Students in the control group were instructed by the teacher per school policy to "Wash your hands then line up for lunch." Intervention 1 consisted of the teacher instructing the students to "Wash your hands then line up for lunch," followed by the teacher walking over to the classroom sink and washing his/her hands. Intervention 2 involved a guest educator teaching a 30-minute grade-appropriate lesson that introduced what germs are, how germs can make people ill, when...